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Health-care reform

Obama plan sets benchmark to begin negotiations

Thursday, June 18, 2009 12:52 AM

There are very few people who would argue against the premise that the current health-care system in America is either viable or functional. The consensus ends there, though, and the process for finding and agreeing on solutions has been as lengthy as it has been contentious, and, thus far, unproductive. Since his candidacy, President Barack Obama has made fixing the nation's health-care system a priority and by delivering his plan to Congress earlier this month, has begun the discussions in earnest. It is necessary work.

The facts that make health-care reform such a pressing issue are beyond dispute: There are as many as 47 million Americans who lack health insurance. Americans spend more per capita on health care than any other country on the planet - $7,900 per person per year - for a total of $2.4 trillion in 2007. That represents 17 percent of the gross domestic product, and total health expenditures were expected to rise nearly 7 percent for 2008. That is twice the rate of inflation. These figures are alarming for a number of reasons, primary among which is the unsustainable nature of their growth. Care is getting more expensive and more difficult to access for more Americans. There simply must be a fix.

But what that fix looks like is a matter of great debate. In his comprehensive plan, Obama attempts to address the issue's three primary factors - access, quality and cost - recognizing they too often run at cross-purposes. The package he is pitching in Congress is almost certainly not what will ultimately be approved, but its broad mandates and offerings are nonetheless important in the process that is to unfold: They represent a vision around which to discuss and negotiate.

Obama's plan would, first and foremost, extend coverage to close the gap from 17 percent uninsured to 6 percent. While that is certainly not perfect, it is a dramatic improvement over the status quo. There are a number of methodologies proposed for achieving this goal, perhaps most contentious among them would be a government-run plan that would compete with private insurers with the dual goal of guaranteeing coverage to all who sought it and forcing, though the competitive marketplace, private insurers to bring down their costs - and therefore the overall cost of care in America.

Not surprisingly, this proposal combined with other tenets in Obama's plan - which altogether could cost $1 trillion over 10 years - has not won many fans in the insurance industry or among Republicans in Congress. It is nevertheless valuable, however, in its role of illustrating the scope of the problem. It also underscores the importance of all involved making some changes to try to solve it. The extent of those changes, how much they will cost, who will have to make the most and who will suffer in the process will cause much wrangling, posturing, party-line toeing and rhetoric lobbing in the weeks and months to come. That is to be expected with any major bill in Congress; when discussing an overhaul of a broken health-care system that is right now vastly profitable for some while inaccessible to too many others, the levels increase exponentially.

In setting a milepost in the path toward fixing the fundamentally damaged health-care system, Obama has begun an effort that is badly needed - for Americans lacking coverage and for the nation's long-term economic viability. What comes out of the process will surely look quite different than what Obama has proposed, but to the extent that negotiations look at a broad range of potential solutions and ask something of everyone with a stake in their outcome - which is every American - the end result can only improve upon the status quo.